Aetiology
- Progressive atherosclerosis in 90%
Risk Factors:
- F > M (4:1)
- History of CAD/PVD
- Smoking
- Diabetes
Pathology
- At least 2 of the 3 main vessels must be stenotic for symptoms to develop
- Single vessel disease develops adequate collaterals
Clinical Presentation
- History
- Post-prandial pain
- Food fear and progressive weight loss
- Malabsorption +/- diarrhoea
- Examination
- Non-specific
- 70% pts will have findings of atherosclerotic disease i.e. PVD, bruit
Diagnosis
- CTA very accurate at identifying atherosclerosis and degree of stenosis at main vessel trunks
- MRA also useful for patients not suitable for IV contrast
- Duplex USS can be used for thin patients
Management
- No treatment for asymptomatic stenosis
- Symptomatic chronic mesenteric ischaemia
- Recommend intervention but high risk of complications
- Haemorrhage and death
- 12% in hospital death and perioperative complications up to 50%
- Open surgical intervention:
- Revascularisation with autologous or prosthetic grafts
- Antegrade/supracoeliac or retrograde/Infrarenal or iliac
- Either single vessel to SMA (50% recurrence) or multivessel repair (10% recurrence but double risk)
- Endovascular options:
- Preferable approach
- Technically difficult due to stenotic calcified vessels
- Arterial access attained under heparin administration
- Primary angioplasty with stenting
- High risk of stent occlusion but can re-angioplasty and still has less risk than surgical intervention